Anterior Wall Of Maxillary Sinus Research Articles

Infratemporal Fossa Schwannoma Surgery via a Combined Prelacrimal Recess, Caldwell-Luc, and Distal Intraoral Approach.

The deep location of infratemporal fossa (ITF) combined with the abundant vascular plexus in it increased the difficulty of removing the mass in ITF through endoscope surgery approach. However, under appropriate circumstances, the excision of ITF tumors through a combined prelacrimal recess, Caldwell-Luc, and distal intraoral approach can be safely performed with minimal impact on the surrounding tissues. The Department of Neurology received a 69-year-old male patient who had been experiencing headache, dizziness, and numbness from the mastoid region of his left ear to the corner of his mouth for a duration of 22 days. Cranial magnetic resonance imaging revealed the presence of a tumor located in the ITF. Following transfer to our department, surgical intervention was performed using a combined approach involving the prelacrimal recess, the anterior wall of maxillary sinus, and lateral ITF to successfully remove the tumor. Postoperative pathologic examination confirmed schwannoma as its nature. The patient was discharged in excellent condition without any functional impairment. On the basis of this case, the authors believe that this combined approach can offer a distinct endoscopic perspective and adequate surgical workspace, which is crucial for tumor removal while preserving the integrity of surrounding normal tissues. Moreover, the utilization of multiple small incisions has minimal impact on postoperative recovery.

Evaluation from the relationship of the root apexes with the maxillary sinus floor and the canine with the y line of ennis in different vertical growth patterns

Introduction: The maxillary sinus has an intimate relationship with the root apexes from the permanent teeth, which may hinder some orthodontic therapies. The objective of this study was to evaluate if the vertical growth pattern interferes with the distance between root apexes and maxillary sinus floor, as well as between root apex of canine and anterior wall of the maxillary sinus and floor of the nasal cavity (Y line of Ennis). Methods: A retrospective analysis was performed by means of Cone-Beam CT scans of 60 individuals (18-36 years) accomplished between 2011 and 2017. Measurements were made from ImplantViewer 3 software, initially determining the evaluation groups (hypodivergent, normodivergent and hyperdivergent) through the Frankfurt-Mandibular Plane Angle (FMA), subsequently subjecting them to the analyzes mentioned above in the objective. Results: There was no significant difference (p > 0.05) between the groups evaluated regarding the distance from root apexes to floor and anterior wall of maxillary sinus. Regarding the root apex of canine and the floor of the nasal cavity, hypodivergents presented smallest distance (p < 0.05). Conclusion: The relation of the root apex with the extremities of the maxillary sinus is independent of the vertical growth pattern, however hypodivergent patients had greater intimacy between root apex of canine and floor of the nasal cavity. Therefore, greater attention is required in the planning of orthodontic mechanics in this group of patients when the distal movement of the canine becomes necessary.

Anterior Wall of Maxillary Sinus as a New Autogenic Graft Source: A Case Report

This study introduces the anterior wall of the maxillary sinus as a viable and accessible graft site for small to moderate bone defects in the maxilla that pose challenges for implantation. A healthy 40-year-old woman was referred by a prosthodontist due to malpositioned implants. Following a comprehensive assessment, the decision was made to remove the implants. Upon executing this treatment plan, a medium-sized defect was revealed. The flap was elevated to expose the anterior wall of the maxillary antrum, from which an osseous graft was obtained. This graft was then fixed as a buccal wall of the defect and supported by a membrane. After a healing period of 6 months, two implants were successfully inserted. The anterior wall of the maxillary sinus can serve as a beneficial graft source. However, more extensive studies with appropriate design are required to reach a definitive conclusion.

Middle superior and anterior superior alveolar nerve injury following trauma to the maxillary sinus: a prospective clinico-radiographic evaluation.

Anterior maxillary sinus wall fractures are common in all types of maxillofacial trauma. They can result in various complications, including injury to the surrounding nerves. Owing to its anatomy, trauma to the maxillary antrum can result in injury to the middle superior alveolar nerve (MSAN) and the anterior superior alveolar nerve (ASAN). The purpose of this study is to evaluate neurosensory deficits (NSD) present in maxillary gingiva, incisors, and premolars after injury to the anterior wall of the maxillary antrum. This prospective study was conducted among 39 patients sustaining unilateral fractures of the anterior maxillary sinus wall. Clinical neurosensory tests including two-point discrimination and fine touch discrimination were performed to classify the extent of nerve injuries as mild, moderate, severe, or anesthetic. Additional temperature discrimination and pulpal sensibility tests (electric pulp testing and cold testing) were carried out. A comparison of radiographic fracture patterns and severity of nerve injury was done. Testing was carried out immediately after trauma and at 2-month follow-up. More than half of the patients assessed in the study group presented with NSD of the teeth and gingiva after trauma. The incidence of deficits varied with the type of test used to measure them. Most frequently, patients presented with both loss of two point as well as fine touch discrimination thresholds. Severe nerve injuries were associated with loss of temperature discrimination clinically and displaced fractures radiographically. There was no significant relationship between the recovery of pulpal and gingival sensation. The patterns of injury and recovery in ASAN and MSAN were similar. NSD after trauma to the maxillary antrum is relatively common. Clinical loss of temperature discrimination and radiographic signs of fracture lines passing through the canalis sinuosus are predictors of persistent and severe oral NSD.

Surgical approach analysis of endoscopic resection of juvenile nasopharyngeal angiofibroma

Objective:To investigate the surgical approach for the resection of juvenile nasopharyngeal angiofibroma（JNA） under nasal endoscopy. Methods:The clinical data of 87 patients undergoing endoscopic resection of nasopharyngeal fibroangioma were retrospectively analyzed. We classified JNA according to tumor site, size, invasion scope and anatomic position relationship between tumor and midline of pupil. Three endoscopic surgical approaches were selected according to the classification, and the postoperative symptoms, complications and recurrence were investigated and analyzed. Results:The tumor resection rate of 87 cases by nasal endoscopic surgery was 100%. Thirty-five cases were approached through the middle nasal passage（small tumors located in the nasal sinuses and pterygopalatine fossa）, forty-five cases were approached through the lateral wall of the nasal cavity（tumor invaded the pterygopalatine fossa but did not exceed the midline of the pupil） , and seven cases were approached via the lateral wall of nasal cavity + ipsilateral anterior wall of maxillary sinus（tumor invaded the infratemporal fossa beyond the midline of pupil or invaded the cavernous sinus and the middle cranial fossa epidural）, Postoperative patients with nasal congestion, nasal bleeding, headache, dizziness, vision loss and other symptoms showed varying degrees of improvement. No surgical death or intracranial infection occurred. The postoperative follow-up was 6-78 months, and the recurrence rate was 3.44%. Conclusion:Endoscopic resection of nasopharyngeal fibroangioma is the main treatment method for JNA. Selecting suitable endoscopic approach to resect JNA, To maximize the advantage of nasal endoscopic equipment according to the inherent anatomical space of the human nasal cavity, In order to achieve the purpose of JNA resection, reduce intraoperative and postoperative complications, reduce the recurrence rate and improve the prognosis.

Facts to Consider in Developing Materials That Emulate the Upper Jawbone: A Microarchitecture Study Showing Unique Characteristics at Four Different Sites.

The maxilla is generally acknowledged as being more trabecular than the mandible. Allograft currently available for use in the maxillofacial region is harvested from the hip and long bones, irrespective of their local characteristics, and grafted onto the jawbones. Other alternative are autograft or commercially available bone substitutes. Due to their inherent differences, an in-depth understanding of the bone microarchitecture is important to develop the most compatible graft for use at the maxilla. This cross-sectional study aimed to determine the microstructures of bone harvested from different sites of the maxilla, to be used for standard setting. Forty-nine specimens from seven human cadavers were harvested from the zygomatic buttress, anterior maxillary sinus wall, anterior nasal spine and anterior palate. Each bone block, measuring of 10 mm × 5 mm, was harvested using rotary instruments. Bone analysis was performed following micro-computed tomography to obtain trabecular number (Tb.N), trabecular separation (Tb.Sp), trabecular thickness (Tb.Th), and bone volume fraction (BV/TV). There were site-related differences, with BV/TV that ranged between 37.38% and 85.83%. The Tb.N was the lowest at the palate (1.12 (mm-1)) and highest at the anterior maxillary sinus wall (1.41 (mm-1)) region. The palate, however, had the highest trabecular separation value (Tb.Sp) at 0.47 mm. The TB.Th was the lowest at the anterior nasal spine (0.34 mm) but both the zygoma and anterior maxillary sinus regions shared the highest Tb.Th (0.44 mm). Except for having the lowest Th.Sp (0.35 mm), the anterior maxillary sinus wall consistently showed higher values together with the zygomatic buttress in all other parameters. Concurring with current clinical practice of harvesting autograft from the zygomatic buttress and anterior maxillary sinus wall, their bony characteristic serve as the microarchitecture standard to adopt when developing new bone graft materials for use in the maxilla.

Use of a Fiberoptic-Laser Approach During Endoscopic Sinus Surgery: A Cadaver Feasibility Study.

The aim of the present study is to evaluate the clinical applicability of laser energy during an oro-nasal endoscopic approach (ONEA) in the management of the anterior maxillary sinus wall. An experiment on three adult human cadavers was performed to study the nasal cavities with angled rigid scopes and using the ONEA technique. In order to evaluate the effectiveness of laser energy on the bone, the drilling effect was compared to laser energy (1470 nm diode laser, continuous wave, power 8, 9 and 10 W). Compared to a rigid angled scope, the ONEA technique allowed complete visualization of the anterior wall of the maxillary sinus. Microscopic analysis of frontal bone revealed similar bone Exeresis with high-speed drilling (270.28 μm) and laser approaches (285.73-456.6 μm). The laser ONEA technique is an innovative, mini-invasive, and safe approach to the anterior wall of the maxillary sinus. Additional study is warranted to further develop this technique.

Effect of anterior maxillary wall shape on ease of prelacrimal recess approach among Asians and Westerners.

Endoscopic sinus surgery has been widely used in the treatment of most maxillary diseases, although the inability to access lesions in the anterior and inferior maxillary sinus walls is a major disadvantage. In few cases, the prelacrimal recess (PLR) approach can be used, which secures an overall view within the maxillary sinus. The distance between the anterior maxillary wall and lacrimal duct is related to the ease of the PLR approach. First we measured the distance between the anterior maxillary wall and lacrimal duct using anatomical image analysis to classify the types and then evaluated whether anatomical factors were related to the results. Both sides of the sinuses were evaluated in 272 participants (544 sides). After marking a tangent line (line 1 [L1]) through the posterior surface of the anterior maxillary sinus wall and a parallel line (line 2 [L2]) to the anterior surface of the lacrimal duct, the vertical distance between L1 and L2 was measured. Vertical distances of < 3mm, 3-7mm, and > 7mm were classified as PLR approach types I, II, and III, respectively. In the axial plane image, line 3 (L3) (a horizontal line starting from the inner anterior maxillary sinus wall) was drawn and the angle with L1 (L1-L3A) was measured. The proportions of types I, II, and III were 23.2% (126), 55.0% (299), and 21.8% (119), respectively. The mean L1-L3As for types I, II, and III were 12.87 ± 4.92°, 11.20 ± 5.08°, and 10.40 ± 4.47°, respectively, showing a significant difference in mean values (p < 0.001). The L1-L3A and vertical distance between L1 and L2 showed a significant negative correlation (r = - 0.201, p < 0.001). We observed a correlation between the distance from the anterior maxillary wall to the lacrimal duct and L1-L3A. The L1-L3A indicates the degree of curvature of the anterior maxillary wall; therefore, the smaller the L1-L3A, the easier it may be to access the PLR.

CALCIFYING ODONTOGENIC CYST WITH 10 YEARS OF EVOLUTION: A CASE REPORT

Calcifying odontogenic cyst (COC) is a rare, benign odontogenic lesion that sometimes may be present along with odontogenic tumors. A 22-year-old female patient was referred for evaluation of an asymptomatic swelling on the anterior maxilla with approximately 10 years of evolution. Physical examination showed firm swelling with cortical expansion within intact bluish mucosa. Computed tomography showed a unilocular hypodense image with hyperdense foci, causing loss of bone structure in the vestibular cortical and anterior wall of maxillary sinus. Diagnostic hypotheses were calcifying epithelial odontogenic tumor, ameloblastic fibro-odontoma, and complex odontoma, and incisional biopsy was performed. Microscopic analysis revealed a pathologic cavity lined by odontogenic epithelium with variable thickness, along with ghost cells, eosinophilic acellular material resembling dentinoid, and foci of dystrophic calcifications. The cyst was surrounded by a fibrous capsule. Histopathologic diagnosis was COC. The patient was referred for enucleation of the lesion for complete analysis and final diagnosis.

Visibility of vascular vessels on anterior wall of maxillary sinus in 3D reconstructed dental CBCT images

ObjectiveThe suitability of different computed tomography (CT) image three-dimensional (3D) reconstruction techniques were investigated for the observation of vascular vessels that supply the maxillary sinus, such as the posterior superior alveolar artery (PSAA), the anterior superior alveolar artery (ASAA), and the infraorbital artery (IOA). Especially the PSAA and its branches have to be taken into consideration during a sinus floor elevation by lateral wall because of the potential risk of heavy bleeding during procedure. MethodsDental cone-beam computed tomography (CBCT) image data including 398 hemi-maxillary sinuses were utilized in this study. Based on the diagnostic impressions from multi planner reconstruction (MPR) images, the diagnostic accuracy and the kappa coefficient of surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) images were examined. ResultsThe overall diagnostic accuracy was 54.2 % in SR, 65.9 % in VR, and 97.9 % in MIP. Cohen's weighted kappa was 0.02 in SR, 0.08 in VR, and 0.59 in MIP images. Only MIP images showed good agreement with MPR findings compared to SR and VR images. ConclusionsMIP 3D images were useful for observation of the entire course of the vascular vessels that supply the maxillary sinus anterior wall.

Sublabial Approach Versus Modified Denker's Procedure: A Comparative Study of Pre-maxillary Tissue Clearance in Covid-Associated Mucormycosis.

To compare the efficacy of the sublabial and modified Denker's procedure in clearance of fungal disease from the anterior wall of maxilla and the pre-maxillary area i.e. the difficult areas of maxillary sinus. A prospective observational study was conducted over a period of 2 months (April 21-June 21) in the ENT department of Sawai Man Singh hospital, Jaipur. All the patients with clinical involvement of the premaxilla or the cheek abutting the anterior wall of maxilla were included in the study population. Cases matched in both groups were subjected to debridement either by the sublabial or the modified denker's approach. Outcomes were measured by assessing the daily CRP values, post-operative DNE every 3days after pack removal, and imaging at the end of 1month. Repeat biopsies were performed in patients that still had persistent symptoms after getting operated on. 16 of the 60 patients (26.6%) operated on by the endoscopic approach showed evidence of residual disease on follow-up whereas only 5 patients (9.6%) in the other category had a similar outcome. Most of the recidivism was seen in the anterior maxilla. Lower rates of complications were found following debridement by the sublabial approach. Since the sublabial approach is the most direct approach for the key areas of fungal involvement of maxillary sinus, it is recommended over the modified Denker's procedure for disease clearance from pre maxilla and the anterior wall of maxillary sinus. This view is also supported by the lower rates of complications encountered following the former.

Long-Term Outcomes of Nasoseptal Perforation Repair Using Anterior Maxillary Sinus Wall as an Interpositional Graft.

Various graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation. The aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation. This is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up. 19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score. Anterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations.

Infraorbital Foramen Decompression Surgery for the Infraorbital Nerve Hypoesthesia in Patients With Isolated Fracture of Maxillary Sinus Anterior Wall.

Isolated fracture of maxillary sinus anterior wall is relatively uncommon. If the extent of fracture is minimal, only conservative care is amenable, however, there is no agreement on whether infraorbital nerve dysfunction can be used as an indication for surgical intervention. This study was conducted to verify the effect of decompression surgery of infraorbital foramen for recovery of hypoesthesia. A total of 26 patients with unilateral fracture of maxillary sinus anterior wall were enrolled. Ten who received only conservative therapy were allocated in the control group, while sixteen patients were assigned to the decompression group. Pre- and post-treatment sensory assessment using visual analogue scale (VAS) was recorded. Overall treatment satisfaction was also evaluated by means of global assessment scale (GAS). Both absolute VAS value and score increment showed statistical difference only at 4 weeks (P = 0.010 and P = 0.021, respectively), but no significant difference at 1, 12, and 24 weeks. GAS score also showed no statistical significance (P = 0.386). Decompression surgery of infraorbital foramen does not have a significant effect on hypoesthesia recovery in isolated fracture of maxillary sinus anterior wall. Therefore, it is not recommended to perform the operation when the infraorbital nerve hypoesthesia is the only indication for the open reduction.

Electric scooter craniofacial trauma.

ObjectiveThe use of standing electronic scooters associated with micromobility applications (e‐scooters) has risen nationally. The aim of this study was to obtain a detailed view of soft tissue and bony craniofacial injury associated with e‐scooter‐related trauma.MethodsSingle‐institution retrospective case series of patients presenting to a level 1 trauma center emergency department or trauma unit with documented e‐scooter‐related craniofacial injury.ResultsOf 203 included patients, 188 (92.6%) patients sustained craniofacial injury. One hundred thirty‐one (64.5%) had exclusively soft tissue injury, 3 (1.5%) exclusively bony injury, 51 (25.1%) both soft and bony injuries, and twenty‐five (12.3%) patients sustained dental injury. Aesthetic units most frequently sustaining acute soft tissue injury were the forehead (n = 106, 34.6%), scalp (n = 36, 11.8%), chin (n = 34, 11.1%), upper lip (n = 32, 10.5%), and cheek (n = 31, 10.1%). Aesthetic subunits most often sustaining acute soft tissue injury included the brow (42, 13.7%), central forehead (39, 12.7%), lateral forehead (n = 25, 8.2%), and upper lip vermillion (n = 23, 7.5%). Craniofacial osseous fracture most often occurred in the orbit (n = 42, 24.6%) and maxilla (n = 40, 23.4%). Individual osseous segments most frequently sustaining acute fracture included the anterior maxillary sinus wall (n = 22, 12.9%), nasal bone (n = 20, 11.7%), lateral orbital wall (n = 16, 9.4%), orbital floor (n = 15, 8.8%), and zygomatic bone (13, 7.6%).ConclusionsOur analysis demonstrates that most patients presenting to our center with craniofacial trauma sustained acute bony fracture, most often to the midface. Our data of common injuries associated with e‐scooter trauma could inform implementation in the form of facial safety equipment or safety skills training for e‐scooter riders.Level of evidence4

An evaluation of the relationship between maxillary sinus anterior wall depression and maxillary sinus opacity by computed tomography and panoramic radiography.

Maxillary sinus anterior wall depression (AWD) has been associated with patterns such as the presence of panoramic innominate line and silent sinus syndrome. The aim of this study was to evaluate the relationship between AWD of maxillary sinus and both maxillary sinus opacity and the presence of innominate line using computed tomography (CT) and panoramic radiography (PR). 250 CT and PR images (122 female, 128male) which had been taken for various reasons were randomly selected from the radiology archive of the our department. Innominate line visibility in PR is divided into three as invisible, obscure and clear. On CT images, the distance between guide line and the deepest point of the maxillary sinus anterior wall was calculated as AWD. The presence of maxillary sinus opacity and maxillary sinus AWD were evaluated on CT images. Demographic information such as age, gender and localization of the findings were noted in all measurements. In 143 (57.2%) patients, the innominate line (clear and obscure patterns) was seen on the PR images. AWD was observed in 104 (41.6%) CT images. The presence of maxillary sinus opacity was observed in 117 (46.8%) images. The mean right anterior wall depth was 5.69 and 4.88 in males and females, respectively, while the mean left anterior wall depth was 5.64 and 4.94 in males and females, respectively. Right wall depth was significantly higher in males (p < 0.05).There was no statistically significant difference in left wall depth (p > 0.05). Anterior wall depression was found to be associated with both maxillary sinus opacity and the visibility of the innominate line. Patients with AWD should be considered as susceptible to maxillary sinus diseases.

Clinical research on the surgical treatment of complex maxillary sinus diseases by pyriform aperture extend prelacimal recess approach

Objective:The aim of this study is to explore the operative method, indication and clinical effect of enlarging anterior lacrimal Fossa via Piriform foramen for complex lesions of maxillary Sinus. Method:By imaging and pathology, twenty-one patients with tumors and bone cysts were confirmed that the lesion base was located in the anterior wall of maxillary sinus, alveolar recess and zygomatic recessor even more broadly. All patients were treated with pyriform aperture extend prelacimal recess approach surgery, and followed up for average 25 months. Result:All the 21 operations went smoothly, including 11 cases diagnosed with papilloma, 4 cases diagnosed with maxillary sinus carcinoma, 1 case diagnosed with moderate dysplasia, 1 case diagnosed with fibroangioma, 1 case diagnosed with schwannomas, 1 case diagnosed with maxillary sinus osteoma, 1 case diagnosed with maxillary sinus bone cyst and 1 case diagnosed with dentigerous cyst. Pyriform aperture extend prelacimal recess approach can thoroughly deal with lesions located in each part of the maxillary sinus. Intraoperative blood loss（191.6±44.7） mL. After operations, 6 patients had mild facial swelling, and 8 cases experienced facial numbness; There were no facial scar, collapse and deformation, anterior nares narrowing, tears overflow and other complications. None of the patients relapsed. Conclusion:The enlarged anterior lacrimal fossa via piriform aperture can provide enough space for complete resection of the complex lesions of maxillary Sinus, which are located in anterior wall, Alveolar recess, zygomatic recess and various parts of the base, the postoperative reaction is light, the complication is few.

Peripheral Ossifying Fibroma in Maxillary Bone

Peripheral ossifying fibroma is a rare fibro-osseous lesion in the practice of otolaryngology. Peripheral ossifying fibroma is frequently seen in craniofacial bones. They are of two types, central and peripheral. Although these lesions can be seen at any age, they are more often seen in women in the second to fourth decade of life. Peripheral ossifying fibromas are generally less than 2 cm, painless, well-demarcated, slowly-growing lesions with pedunculated or sessile. Approximately 60% of it occurs in the anterior part of the maxillary bone. The diagnosis is made clinically, radiologically and histopathologically. Surgical excision should be performed to prevent recurrence and patients should be followed up for a long time. In this study, the clinical, radiological and surgical characteristics of a 33-year-old patient with peripheral ossifying fibroma in the maxillary sinus anterior wall were discussed in the light of the literature.

Submandibular approach for tracheal intubation of maxillofacial fracture patient

Introduction: Airway management of facial trauma patients remains a challenge for anaesthesiologists. Alternatives are needed for patients who are unable to perform the nasotracheal or orotracheal intubation commonly used in general anaesthesia for dental surgery. However, if prolonged maintenance of airway or ventilation is not needed, tracheostomy is not an appropriate alternative. Objectives/Aims: We report a case of submandibular intubation using sterile disposable camera cable drape (Sani-sleeve®) to minimise the injury caused by surgical intubation. CASE REPORT: The patient was diagnosed with LeFort II fracture (both), LeFort III fracture (Lt.), Infraorbital wall fracture, maxillary anterior alveolar fracture, maxillary sinus anterior wall fracture, and lower lip laceration due to facial trauma. The nasotracheal and orotracheal intubation were impossible. Therefore, we decided to perform submandibular intubation to reduce the sequelae of invasive tracheostomy. Then awake fibreoptic orotracheal intubation was performed successfully with 7.5 mm sized reinforced tube. After confirming the success of orotracheal intubation, submandibular approach for tracheal intubation was started. Submandibular incision (2 cm) was performed on two fingers away from the right mandibular border. We made a tunnel by blunt dissection with Kelly forceps and dissecting scissors to right oral cavity floor. The Sani-sleeve® (Camera cable drape) was passed with Kelly forceps through a tunnel from extraoral to intraoral space. Another 7.5 mm sized reinforce tube was passed into the Sani-sleeve® to dilate the space which the intubated tube would pass. After confirming that space was created, the intubated tube was repositioned to extraoral space through the Sani-sleeve® tunnel and fixed. At the end of the surgery, the submandibular intubated tube was repositioned again to the oral cavity. Conclusion: This case suggests that submental or submandibular intubation can be an appropriate alternative to the tracheostomy.

THE USE OF BUCCAL ANTROSTOMY BONE AS A GRAFT FOR CLOSURE OF ORO- ANTRAL FISTULA

INTRODUCTION: Oroantral fistula is an epithelialized, pathological and unnatural communication between the oral cavity and the maxillary sinus. OBJECTIVES: The aim of this study was to evaluate the use of buccal antrostomy bone as a graft for closure of oroantral fistula clinically and radiographically. MATERIALS AND METHODS: A prospective study was done on 10 patients complaining of oroantral fistulae following extraction of maxillary posterior teeth. The bony defect of the oroantral fistula was closed by anterior wall of maxillary sinus as a graft material and fixed to the surrounding bone using N-Butyl-2-Cyanoacrylate (Histoacryl®), then covered by buccal advancement flap. The patients were followed up clinically after 4, 6, 8 and 12 weeks postoperatively Radiographic evaluation was performed by cone beam computed tomography (CBCT) preoperatively and after 12 weeks postoperatively. RESULTS: Evaluation of the patients revealed that proper healing of the wound occurred in most of the patients except in 3 patients whose bone graft was exposed and removed. Radiographicaly, significant amount of bone was formed comparing the preoperative and postoperative CBCT of the patients. CONCLUSIONS: According to the results of the present study, it is concluded that the use of the buccal antrostomy wall as a bone graft fixed with N butyl cyanoacrylate proved successful results in closure of large oroantral fistula.

Application of a Lateral Pedicled Cranial Bone Flap for the Treatment of Secondary Zygomaticomaxillary Defects.

This study aimed to evaluate the effect of laterally-based pedicled cranial bone flap (LBPCBF) for the repair of secondary zygomaticomaxillary defects. Between December 2014 and December 2016, 6 patients with unilateral zygomaticomaxillary defects were selected; of these, 5 had trauma, and 1 was exposed to titanium mesh in the infraorbital area due to radiotherapy following total maxillectomy for right maxillary squamous cell carcinoma. Preoperatively, 3 patients suffered from an intraoral vestibular groove fistula, 2 suffered from an extraoral fistula, and 1 from local exposure of titanium mesh. Surgical treatment was implemented in all 6 patients, of which, the 5 trauma patients underwent debridement, reduction, and fixation of periorbital fracture, followed by repair of the defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body with LBPCBF, and then, reconstruction of the orbital floor with titanium mesh. The other patient with exposed titanium mesh underwent repair of defects in the infraorbital margin and anterior wall of the maxillary sinus with LBPCBF after titanium mesh trimming. Postoperative review at 6 months revealed disappearance of intraoral fistula, wound healing, and improvement of facial deformity in all 6 patients, of which 2 patients demonstrated postoperative ectropion. The application of LBPCBF can simultaneously repair bone defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body, as well as, supplement the soft tissue, thereby indicating a satisfactory treatment effect.